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57 Cards in this Set

  • Front
  • Back
Intramedullary Edema – DDx
1. Transverse myelitis – idiopathic, viral, MS
2. Sarcoid
3. SLE
4. Dural AV fistula
5. Astrocytoma
6. Ependymoma
7. Post-traumatic edema
8. Mets
9. Spinal Cord Infarct
Cystic Masses within Spinal Canal – DDx
1. Hydrosyringomyelia
2. Ependymoma
3. Astrocytoma
4. Hemangioblastoma
5. Spinal Cord Herniation
6. Arachnoid Cyst
7. Meningeal diverticulum/Cyst
8. Cysticercosis
9. Neuroepithelial Cyst
10. Neuroenteric Cyst
Enhancing Intradural Extramedullary Masses – DDx
1. Drop Metastases (Primary CNS or systemic malignancy)
2. Schwannomas
3. Meningioma
4. Exophytic glial neoplasm
5. Filar ependymoma
6. PNET
Enhancing Intradural Nerve Roots – DDx
1. Leptomenigneal Metastases
2. Arachnoiditis
3. Nerve root compression
4. Meningitis (Chemical, infectious, carcinomatous)
5. CMV radiculitis
6. guillain-Barre Syndrome
7. AV Fistula
Intramedullary Lesion
1. Tumor
a. Ependymoma – 60%
b. Astrocytoma – 25%
c. Oligodendroglioma - 3%
d. Epidermoid, dermoid, teratoma (1-2%)
e. Lipoma
2. Cystic Lesion
f. Syringomyelia
g. Hydromyelia
h. Reactive Cyst
i. Hemangioblastoma
3. Vascular
j. Cord concussion
k. Hemorrhagic contusion
l. Cord transection
m. AVM
4. Chronic Infection
n. Sarcoid
o. Transverse Myelitis
p. MS
Intramedullar Cord Lesion
I’M ASHAMED
1. Inflammation – MS, transverse myelitis, sarcoidosis)
2. Medulloblastoma
3. Astrocytoma
4. syringomyelia, hydromyelia
5. Hematoma, Hemangioblastoma
6. AVM
7. Mets
8. Ependymoma
9. Dermoid
Intradural Extramedullary Mass
1. Neurofibroma – 25-35%
2. Meningioma
3. Lipoma
4. Dermoid – commonly conus/cauda, a/w spinal dysraphism
5. Ependymoma
6. Drop mets from CNS tumors
7. Mets from extra-CNS tumors
8. Arachnoid cyst
9. neurenteric cyst
10. Hemangioblastoma
Intradural Extramedullar Mass
MAMA N
1. Mets
2. Arachnoiditis
3. Meningioma
4. AVM, arachnoid cyst
5. Neurofibroma
Epidural Extramedullary Lesion
1. Benign Tumor
a. Dermoid, epidermoid
b. Lipoma
c. Fibroma
d. Neurinoma/schwannoma – with intradural component
e. Meningioma – with intradural component
f. Ganglioneuroblastoma, ganglioneuroma
2. Malignant Tumor
g. Hodgkin Disease
h. Lymphoma – dorsally
i. Mets – breast, lung, from VB
j. Paravertebral Neuroblastoma
k. Chordoma
3. Disk Disease
l. Bulging disk, herniated disc, sequestered disc fragment
4. Osseous spinal stenosis, spondylosis
5. Inflammation – epidural abscess
6. Hematoma
Neurogenic Tumor (Neurinoma) – types
1. Arising from nerve sheath
a. Schwannoma – antoni A (cellular) and B (myxoid), most sporadic, 15-20% NF2
b. Neurofibroma – NF1, potential for malignant transformation,
2. Originating from Nerve
c. Neuroma – posttraumtic lesion at end of severed nerve
d. Neurilemoma
Cord Atrophy – DDX
1. MS
2. Amyotrophic Lateral sclerosis
3. Cervical spondylosis
4. Sequela of trauma
5. Ischemia
6. Rtx
7. AVM
Lumbosacral Post-surgical Syndrome
1. Biomechanical Failure
a. Primary disc herniation
b. Recurrent disc herniation (1 week – 1 month)
2. Failure of Treatment
c. residual disc herniation (onset < 1 week)
d. perioperative intraspinal hemorrhage
e. spinal/meningeal/neural inflammation
f. Intraspinal scar formation - > 1month
i. Epidural fibrosis
ii. Fibrosing arachnoiditis
Failed Back Surgery Syndrome –
1. Definition
2. Causes
1. Failure of improvement following back surgery (5-15%), difficult in immediate postop pd, stabilization of findings over 2-6 moths
2. DDx
a. Osseous Causes
i. Spondylisthesis
ii. Central Stenosis
iii. Foraminal stenosis
iv. Pseudoarthrosis
b. Soft Tissue Causes
i. Adhesive arachnoiditis
ii. Infection
iii. Hemorrhage
iv. Epidural fibrosis (scarring)
v. Recurrent disc herniation
c. Surgical Errors
i. Wrong level/side of surgery
ii. Direct nerve Injury
Failed Back Surgery Syndrome – DDx
ABCDEFG
1. Arachnoiditis
2. Bleeding
3. Contamination (infection)
4. Disc (residual/recurrent/new level)
5. Error (level)
6. Fibrosis (scar)
Cauda Equina Syndrome – DDx
1. displaced disc fragment
2. intra/extramedullar tumor
3. Osseous: paget dz, osteomyelitis, osteoarthrosis of facet joint, ank spon
Long Epidural Lesions of the Spine – DDx
1. Epidural Lipomatosis
2. Metastases
3. AVMs
4. Extramedullary hematopoiesis
5. OPLL
6. Lymphoma
7. Neuroblastoma
8. Epidural Abscess
9. Epidural Hematoma
Sacral/Presacral Masses – DDx
1. Chordoma
2. Giant Cell Astroctyoma
3. Mets
4. Sacrococcygeal teratoma
5. Tarlov Cysts
6. Plasmacytoma
7. Neuroblastoma
8. Ganglioneuroma
9. Plexiform Neurofibroma
Osteolytic Lesion of Skull
1. Normal variant
a. Emissary vein
b. Venous Lake
c. Pacchionian granulations
d. Parietal foraminae (normal or giant)
2. Trauma
e. Surgical burr hole
f. Leptomeningeal cyst
3. Infection
g. Osteomyelitis
h. Hydatid disease
i. Syphilis
j. Tb
4. Congenital
k. Dermoid/Epidermoid
l. NF (asterion defect)
m. Meningoencephalocele
n. Osteoporosis circumscripta of Paget Dz
o. Fibrous Dysplasia
5. Benign Tumor
p. Hemangoma
q. Brown Tumor
r. EG
6. Malignant Tumor
s. Solitary/multiple mets
t. Multiple myeloma
u. Plasmacytoma
v. Leukemia
w. Neuroblastoma
Solitary Lytic Lesion in Skull
HELP MFT HOLE
1. Hemangioma
2. Epidermoid/Dermoid
3. Leptomeningeal Cyst
4. Postop/Paget Dz
5. Mets, Myeloma
6. Fibrous dysplasia
7. Tb
8. Hyperparathyroidism
9. Osteomyelitis
10. Lambdoig defect (NF)
11. Eosinophilic Granuloma
Multiple Lytic Lesions in Skull
BAMMAH
1. Brown Tumor
2. AVM
3. Myeloma
4. Mets
5. Amyloidosis
6. Histiocytosis
Spinal Segmentation Anomalies
1. Asomia
2. Hemivertebra
3. Coronal cleft
4. Butterfly vertebra
5. Block vertebra
6. Hypoplastic vertebra
7. Klippel-Feil syndrome
Small Vertebral Body – DDx
1. RTx
2. Juvenile rheumatoid arthritis – cspine
3. EG – vertebra plana
4. Gaucher dz – compression deformity (deposits of glucocerebrosides within RES)
5. Plastyspondyly generalisata (hereditary disorders inc. achondroplasia, mucopolysacharidosis, osteopetrosis, NF, OI)
Vertebral Plana
FETISH
1. Fracture (trauma, OI)
2. EG
3. Tumor – Lymphoma, Leukemia, mets)
4. Infection
5. Steroids (avascular necrosis)
6. Hemangioma
Enlarged Vertebral Body – DDx
1. Pagets DZ – picture framing
2. Gigantism
3. Myositis ossificans progressive
Straightening of Anterior Border
1. Ankylosing Spondylitis
2. Paget Dz
3. Psoriatic arthritis
4. Reiter disease
5. RA
6. Normal Variant
Anterior Scalloping of Vertebrae
1. Aortic Aneurysm
2. Lymphadenopathy
3. Tb
4. Multiple Myeloma
Posterior Scalloping of Vertebrae
Dural Ectasia
1. Increasing Intraspinal Pressure
a. Communicating hydrocephalus
b. Ependymoma
2. Mesenchymal tissue laxity
c. NF
d. Marfan Syndrome
e. Ehlers-Danlos
f. Posterior Meningocele
3. Bone Softening
g. Mucopolysaccharidoses: Hurler, Morqui, Sanfilippo
h. Acromegaly (lumbar vertebrae)
i. Ankylosing spondylitis (lax dura acting on osteoporotic vertebrae)
j. Achondroplasia
Bony Projections from Vertebra
1. LOWER 1/3 ANTERIOR BEAK
a. Hurler syndrome – LOWER 1/3 anterior beak, mild kyphotic curve
b. Achondroplasia
c. Cretinism (hypothyroidism)
d. Down syndrome
e. Neuromuscular diseases

2. CENTRAL ANTERIOR BEAK
f. Morquio disease – flat/wide vb’s
3. Spondylosis Deformans – osteophytes along anterior and lateral endplstes with horizontal/vertical course (sharpey’s)
4. DISH – Diffuse idiopathic skeletal hyperostosis, Forrestier disease, flowing Ca+/ossification alaong anterolateral aspect of >= 4 contiguosu thoracic vertebral bodies
5. Ankylosing Spondylitis – bil symmetric syndesmophytes (ossification of annulus fibrosus), bamboo spine, discal ballooning (biconvex discs) 2º osteoporotic endplate deformity
6. Fluorosis
Spine Ossification Patterns and associations
1. Syndesmophyte – ossification of annulus fibrosus, ankylosign sponydilitis, ochronosis
2. Osteophyte - ossification of ALL, osteoarthritis
3. Flowing Anterior Ossification – DISH
4. Paravertebral ossification – psoriatic arthritis, Reiter syndrome
Vertebral endplate Abnormality
1. Osteoporosis – senile, steroids, fish vertebrae
2. Sickle Cell Disease – H vertebrae – central compression due to subchondral infarcts
3. Schmorl Node
4. Limbus vertebrae (anteriosuperior corner
5. Ring epiphysis – normal b/w 6-12 yo, small steplike recess at corner of anterior vb edge
6. Renal Osteodystrophy – rugger jersey spine
7. Myelofibrosis – rugger-jersey spine – thick bands
8. Osteopetrosis – sandwich vertebrae – thin sclerotic endplates
Schmorl Node – DDx
SHOOT
1. Scheurmann disease
2. Hyperparathyroidism
3. Osteoporosis
4. Osteomalacia
5. Trauma
Intervertebral Disc Calcification
CHOW
1. CPPD
2. Hemochromatosis
3. Ochronosis
4. Wilson Disease
Bullet-shaped Vertebral Body
HAM
1. Hypothyroidism
2. Achondroplasia
3. Morqui syndrome
Bone-within-bone Vertebra
1. Stress line
2. Leukemia
3. Heavy metal poisoning
4. Thorotrast injection , TB
5. Rickets
6. Scurvy
7. Hypothyroidism
8. Hypoparathyroidism
EXPANSILE LESION OF VB: Multiple VB Involvement
1. Mets
2. Multiple Myeloma
3. lymphoma
4. hemangioma
5. Paget disease
6. angiosarcoma
7. EG
EXPANSILE LESION OF VB: Involvement of Two/More Contiguous Vertebrae
1. Osteochondroma
2. chordoma
3. aneurismal bone cyst
4. myeloma
EXPANSILE LESION OF VB: Benign lesions
1. Osteochondroma
2. Osteoblastoma – posterior elements, cervical, calcified tumor matrix
3. Giant Cell Tumor – sacrum, malignant degen 15-20%
4. Osteoid osteoma
5. Aneurysmal Bone cyst – arise from primary bone lesion (GCT, fibrous dysplasia)
6. Hemangioma
7. Hydatid Cyst
8. Paget disease – picture framining, enlargement
9. EG –
10. Fibrous Dysplasia – ground glass
EXPANSILE LESION OF VB: Malignant Lesions
1. Chordoma
2. Metastases – pedicles often destroyed
3. Multiple Myeloma/Plasmacytoma – pedicles usually spared
4. angiosarcoma
5. Osteosarcoma, chondrosarcoma
6. Lymphoma
Bone Tumors Favoring Vertebral Bodies
CALL HOME
1. Chordoma
2. ABC
3. Leukemia
4. Lymphoma
5. Hemangioma
6. Osteobastoma, osteoid, osteoma
7. Myeloma, Mets
8. EG
Priamry Vertebral Tumors – Peds
1. Osteoid Osteoma
2. Benign Osteoblastoma
3. ABC
4. Ewing sarcoma
Blow Lesion of Posterior Elements
GO APE
1. GCT
2. Osteoblastoma
3. ABC
4. Plasmacytoma
5. EG
Primary Tumor of Posterior Elements
A HOG
1. ABC
2. Hydatid Cyst, Hemangioma
3. Osteoblastoma, Osteoid Osteoma
4. GCT
Cervical Spine Fusion
SPAR BIT
1. Senile hypertrophic ankylosis (DISH)
2. Psoriasis, progressive myositis ossificans
3. Ank Spon
4. reiters disease, RA (juvenile)
5. Block vertebra (Klippel-Feil)
6. Infection (Tb)
7. Trauma
Fused Vertebrae
1. Isolated congenital (References only)
2. Klippel-Feil syndrome (References only)
3. Rheumatoid arthritis
4. Ankylosing spondylitis
5. Tuberculosis
6. Operative fusion
7. Post traumatic (References only)
Odontoid Erosion
P LARD
1. Psoriasis
2. Lupus
3. Ankylosis Spondylitis
4. RA
5. Down syndrome
Spina Dysraphism – types
1. Occult – spina bifida occulta
2. meningocele
3. myelocele
4. myelomeningocele
5. lipomyelomeningocele
6. myelocystocele
7. myeloschisis
Atlantoaxial Subluxation – Causes
1. Congenital – occipitalization of atlas, congenital insufficiency of transverse ligament, os odontoideum/dens aplasia, down syndrome (20%)_, morqui syndrome, bondy dysplasia
2. Arthritis – laxity or transverse ligament, dens erosion
a. RA, psoriatic, Reiter, anklyosing spondyltiis, SLE
3. Inflammatory Process – pharyngeal infection, retropharyngeal abscess, Otitis media, mastoiditis, cervical adenitis, parotitis, alveolar abscess
4. Trauma (very rare without dens fx)
5. Marfan disease
Atlantoaxial Subluxation
JAP LARD
1. Juvenile RA
2. Ank spon
3. Psoriatic
4. Lupus
5. Accident (trauma)
6. Retropharyngeal abscess, RA
7. Down
Sacral Neoplasms
SPACEMON
1. Sarcoma
2. Plasmacytoma
3. ABC
4. Chordoma
5. ependymoma
6. Metastasis (breast, kidney, cervix, colon)
7. osteomyelitis
8. Neuroblastoma
Complications of Cervical Spine Fixation Surgery 
1. Soft tissue complications
a. Wound Infection
b. Seroma and epidural scar
c. Epidural hematoma - CT
d. Epidural hematoma - MRI
2. Bone/Bone graft complications
e. Nonunion
f. Endplate Fracture
g. Graft Collapse
h. Graft Reabsorption
i. Displaced Strut Graft
j. Instability
3. Hardware complications
k. Screw in disc space  
l. Screw displacement  
m. Screw backing out
n. Screw in spinal canal
o. Screw loosening
p. Screw loosening and hematoma
q. Broken screw
r. Slipped rod
Multiple Collapsed Vertebrae
1. Osteoporosis
2. Neoplastic Disease
3. Trauma
4. Scheurmann’s Disease
5. Infection
6. EG
7. Sickle Cell anemia
Erosion, destruction or absence of a pedicle
1. Metastasis
2. Multiple myeloma
3. Intraspinal mass (References only)
4. Aneurysmal bone cyst
5. Giant cell tumor
6. Congenital abscence (References only)
7. Tuberculosis
8. Benign bone
Squaring of one or more vertebral bodies
1. Alkylosing spondylitis
2. Paget's disease
3. Psoriatic arthropathy
4. Reiter's syndrome
5. Rheumatoid arthritis
Conditions producing disc space narrowing
1. Infection
2. Mastocytosis
3. Myelofibrosis
4. Lymphomas
5. Paget's disease
6. Fluorosis
7. Renal osteodystrophy
8. Axial osteomalacia
Intervertebral disc calcifications
1. Degenerative spondylosis
2. Alkaptonuria
3. CPPD
4. Ankylosing spondylitis
5. Juvenile chronic arthritis
6. Hemochromatosis
7. Diffused idiopathic skeletal hyperostosis
8. Gout
9. Idiopathic
10. Post spinal fusion
Anterior scalloping of the sacrum
1. Metastasis
2. Multiple myeloma
3. Posterior soft tissue pelvic tumors
Ivory vertebrae
1. Metastases
2. Paget's disease
3. Lymphoma
4. Low-grade infection